Most exercise-based speech therapy programs developed for persons with Parkinson’s disease focus on daily home practice as an important component of brain re-training.

However, there is also an underlying assumption that individuals with motor speech problems resulting from Parkinson’s disease have a sensory-perceptual disconnect or deficit that contributes to their inability to accurately judge their speech/voice loudness and clarity. So, if this is a true assumption, than how do patients know if they are engaging in good, high quality speech practice?

Researchers have examined practice habits of elite athletes and non-expert athletes to understand the effects of sport specific practice in the development of a sport. (Baker, Cote, and Abernethy 2003), and discuss the differences between deliberate practice, the type employed by expert athletes, and deliberate play, participation in non-competitive athletic endeavors.

Deliberate practice requires that expert athletes engage in high accumulated hours of practice time and the practice must be high quality. The characteristics of deliberate practice include, immediate access to feedback from coaches, a drive for perfection, high levels of repetition, maximum effort expenditure, complete concentration, long hours of practice, and performed for improvement rather than enjoyment. This type of practice might be similar to speech therapy practice when enrolled in out-patient therapy employing a specific protocol.

Motivation has also been explored as a factor contributing to an elite athlete’s performance, and when the motivation source is extrinsic (eg: attaining trophies, titles, money, or external pressure from coaches and parents) fear of failure and reduced motivation may lead to a dropout from the sport. A key characteristic of deliberate practice is the lack of enjoyment or focus on fun.

Lack of fun makes an activity such as deliberate practice become entrapment; this soon leads to burnout which in turn can lead to withdraw from the sport. Similarly, when patients are expected to continue to engage in rigorous practice following speech therapy, it may begin to feel like all work and no fun.


Deliberate play can be seen as the opposite of deliberate practice as the focus here is of enjoyment. A key characteristic of deliberate play is that it is intrinsically motivated and designed to foster high levels of fun and natural skill development. The motive for engaging in this style of play is not for skill development or performance improvement (although this can be a bi-product), and there is no specific outcome goals in mind such as playing with a view to enter in to competition, or to become a national champion.

Research has shown that athletes who engaged in deliberate play and who went on to become experts in their sport also reported the greatest levels of intrinsic motivation resulting in long term adherence, consistently high levels of motivation, and enjoyment from playing their sport. Researchers Baker and Bertsch (2010) looked at youth experiences of expert athletes and found that deliberate practice and deliberate play both played a crucial role in the development of skill and creativity of athletes.

When sport becomes more work than play, athletes struggle, they grind, and if they cannot get back to playing instead of working, they eventually drop out.Could the same be true for patients?


If therapy is only about speech drills, a focus on what’s wrong with one’s speech/voice or body, what someone can’t do or needs to do, rather than having fun, how long will they adhere to a rigid schedule of practice?

Beyond Speech Therapy: The 4C’s and Communication

Borrowing again from sports, members of a weekly speech class for persons with Parkinson’s have the opportunity, to develop communication skills through practice, peer coaching, and FUN! The result of speech practice that feels like play may yield the 4C’s:

  • Competence:  A positive view of one’s action in speaking; learning specific skills, and employing them when speaking/performing.
  • Confidence: An internal sense of positive self‐worth in communicating.
  • Connection: Positive bonds with other people with Parkinson’s and the opportunity to provide peer support and coaching.
  • Character: Respect for and awareness of conversational rules, integrity, and empathy for others.

Congratulations Barry Jones Pedaling 4 Parkinson’s

I received a recent email from the wife of a former patient, Barry Jones, celebrating his completion of a benefit bike ride for Parkinson’s research.

Mary Neal reported: “It was a beautiful Colorado day, cool and sunny, and the ride meandered through the foothills with gorgeous views of mountains and meadows around every turn  – all 10 miles with smiles on our faces (except on the hills, of course).  We are so grateful to have been able to do this. Barry and Joe, his captain on the tandem bike they rode together were magnificent .One of the most amazing aspects of the ride was the impact that forced exercise had on Barry. Immediately after the ride, his voice was strong, his smile was wide, and his movement was much easier and freer. He was so fully himself without barriers for the afternoon and evening after the ride!”

To learn more about Pedaling 4 Parkinson’s visit:

Just in time for my birthday, the Hi-Volt® voice-on-light bracelets are finally on their way. Due to overwhelming response to the Hi-VOLT, we sold out of stock in April, and planned to re-stock in May, but then an issue occured with the manufacturer, and well, here we are, 3 months later, finally in receipt of a new shipment. I have been tracking the order which has been held up in customs in Miami since the end of June, but finally appears to have cleared. Who knew so many customs agents wanted to improve use of their voice!

My apologies to customers who ordered back in April and May, and a big THANK YOU for your patience. 

Speak Up and See the Light

The Hi-VOLT bracelet is a calibrated, voice activated feedback tool which can help users in and out of speech and physical therapy. Just speak loud enough to activate the light. The accompanying audio CD will guide users through 22 minutes of home practice. To order a Hi-Volt® 4 PD voice-on-light and audio CD visit:

My Mission:To enlist individuals in their treatment, and help them express their personality & spirit through voice. To educate and empower.
Mary Spremulli, MA, CCC-SLP